RESULTS : Table 1: Demographics Factors associated with presence of tender trigger points on shoulder girdle muscles in Occipital neuralgia Soma Sahai-Srivastava, M.D. , Dawood Subhani, MBBS University of Southern California, Los Angeles, California Replace with logo Background & Methods Results The I.H.S. criteria for Occipital neuralgia (ON) include 1. Unilateral headache, continuous or paroxysmal 2. diminished sensation or dysaesthesia in the affected area. 3. Circumscribed tenderness over the GON as it crosses the superior Nuchal line 4. Relief of acute attack by local anesthetic block Diagnostic criteria for Fibromyalgia comprise presence of 18 symmetric tender trigger points including those on the Trapezius, rhomboid and suboccipital notch. Retrospective chart review of 94 consecutive patients presenting (2005 - Jan 2011) with ON. Ours is the first large case series study reporting the presence of tender trigger points on shoulder girdle muscles in ON in the absence of Fibromyalgia. 44 ON (47%) patients had at least 1 Trigger point (TP) of which 31 received Trigger point injection (TPI). 18 patients had TPI on Trapezius and 26 on the Rhomboids. Of the 61 patients who received bilateral ONB, 13 (21%) had bilateral Trapezius TPI ( p=0.06) and 11 had bilateral Rhomboids TPI (18%). The correlation of laterality of ON block (ONB) with TPI showed a non significant trend towards bilateral Trapezius TP in bilateral ONB patients. RESULTS : Table 1: Demographics ON Block Trigger Points No of subjects 94 44 ( 47%) Age (years), mean 54.3 53 Female, no. (%) 54 (57) 31 (71) Race, no. (%) White 55 (58 ) 27 (61) Hispanic 29 (31) 1 4(32) African American 2 (2) 1 (2) Asian 8 (8) 2 (5) Migraineurs 44 (47) 20 (48) Bilateral 61 (64) 24 (21) Methods Conclusion ON patients should be screened for tender trigger points on Trapezius and Rhomboid muscles even in the absence of Fibromyalgia. Bilateral ON may have a higher frequency of bilateral trigger points. References 1.Sahai-Srivastava S., Macwan S. Atypical Facial Neuralgia. Practical Pain Management.2004; 4(6): 49-52 2.Anthony M. Headache and the greater occipital nerve. Clinical Neurology and Neurosurgery. 1992; 94: 297-301 3.Saadah HA and Taylor FB. Sustained Headache Syndrome Associate with Tender Occipital Nerve Zones. Headache, 1987;27: 201-205. 4.Gawel MJ and Rothbart PJ. Occipital Nerve Block in the Management of Headache and Cervical Pain. Cephalalgia, 1992 12:9-13 5. Sahai-Srivastava S, Zheng, L. Occipital neuralgia with and without migraine difference in pain characteristics and risk factors. Headache 2011; 51(1):124-8. 6.. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004; 24 Suppl1:9 160. 7. Wolfe F, Smythe HA,Yunnus MB, Bennett RM,Bombardier CGoldenberg DL,Tugwell P, Abeles M,Campbell SM,Clark P et al. The American College of Rheumatology 1990 Criteria for The Classification of Fibromyalgia: Report of Multicenter Criteria Committee Arthritis Rheumatism 1990; 33:160-172. None of the patients had a history of Fibromyalgia All patients reported pain relief with injections. There was no correlation between age, gender, race, history of migraine headache and presence of TP